Abstract
Objective
To compare cognitive outcomes of patients undergoing open radical nephrectomy (RN)
and inferior vena cava (IVC) thrombectomy with vs without cardiopulmonary bypass (CPB)
and deep hypothermic circulatory arrest.
Patients and Methods
A prospective, 6-month, observational study was conducted from January 2013 to December
2019 in renal cell carcinoma patients with level II-IV IVC thrombus undergoing RN.
A battery of standardized neuropsychological tests was administrated to assess multi-domain
cognitive function before surgery, 1 week, and 6 months after surgery: attention,
executive functions, working memory, short-term and long-term delay recall, visuomotor
speed, and verbal fluency.
Results
Cognitive impairment was defined as a 20% reduction in at least 20% of the main variables.
The primary outcome was the incidence of cognitive impairment at 6 months postoperatively
and was analyzed with general linear mixed models. Twenty-six patients treated with
CPB and 39 treated with non-CPB were analyzed. There were no significant differences
in cognitive impairment between the two groups. The incidence of cognitive impairment
at 1 week postoperatively was 38.5% in CPB group and 30.8% in non-CPB group (P = .52), after 6 months 11.5% and 10.3% (P = 1.00). Multivariate analysis indicated that the estimated blood loss was the only
risk factor associated with cognitive impairment at 1 week postoperatively.
Conclusion
This study showed no significant differences in postoperative cognitive function of
renal cell carcinoma patients after open RN and IVC thrombectomy with and without
CPB and deep hypothermic circulatory arrest. Estimated blood loss was found to be
associated with cognitive impairment at 6 months postoperatively.
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Article info
Publication history
Published online: March 21, 2022
Accepted:
March 6,
2022
Received:
December 8,
2021
Footnotes
Funding Support: This work was supported by 21ZR1438900 from Natural Science fund of Shanghai, PYIII20-07 from the Incubating Program for Clinical Research and Innovation of Renji Hospital, PYXJS16-008 from the Incubating Program for Clinical Research and Innovation of Renji Hospital, BCF-NH-ZL-20201119-024 from Basic Oncology Research Program of Bethune Charitable Foundation.
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